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The cerebral cortex is responsible for thought, memory, reasoning, sensation, and voluntary movement.
The wife of a 65-year old man tells you she is concerned because she has noted a change in his personality and ability to understand. He also cries and becomes angry easily. Which cerebral lobe is responsible for these behaviors?
Loss of vibration sense occurs with peripheral neuropathy (e.g., diabetes and alcoholism). Peripheral neuropathy is worse at the feet and gradually improves as you move up leg, as opposed to a specific nerve lesion, which has a clear zone of deficit for its dermatome
During the history, a patient tells you that “it feels like the room is spinning around me.” You would document this as:
A change in consciousness may be subtle. Note any decreasing level of consciousness, disorientation, memory loss, uncooperative behavior, or even complacency in a previously combative person.
Some hospitalized persons have head trauma or a neurologic deficit from a systemic disease process. These people must be monitored closely for any improvement or deterioration in neurologic status and for any indication of increasing intracranial pressure. Use an abbreviation of the neurologic examination in the following sequence: level of consciousness, motor function, pupillary response, and vital signs.
Ensure validity of sensory system testing by making sure the person is alert, cooperative, and comfortable and has an adequate attention span. Otherwise, you may get misleading and invalid results.
In a brain-injured person, a sudden, unilateral, dilated, and nonreactive pupil is ominous. Cranial nerve III runs parallel to the brain stem. When increasing intracranial pressure pushes the brainstem down (uncal herniation), it puts pressure on cranial nerve III, causing pupil dilation.
-Ptosis- drooping of eyelid (myasthenia gravis, Horner syndrome)
-Strabismus- deviated gaze
-Nystagmus- back and forth oscillation of eyes
End-point nystagmus at an extreme lateral gaze occurs normally. Assess any other nystagmus carefully. Severe nystagmus occurs with disease of the vestibular system, cerebellum, or brainstem.
The findings listed reflect a dysfunction of the motor component of cranial nerve VII as well as the sensory afferent in cranial nerve V.
You are testing the function of cranial nerve XI. Which of the following best describes the response you would expect if the nerve was intact?
Some aging adults show a slower response to requests, especially for those calling for coordination of movements. The findings listed are normal in the absence of other significant abnormal findings.
During the finger-to-finger test, if the person has clumsy movement with overshooting the mark, either a cerebellar disorders or acute alcohol intoxication should be suspected.
ANS: 3Slow clumsy movements and the inability to perform rapid alternating movements occur with cerebellar disease. The condition is termed dysdiadochokinesia
These findings are all indicated of decerebrate rigidity, which is a very ominous condition and may indicate a brainstem injury.
With spastic hemiparesis, the arm is immobile against the body. There is flexion of the shoulder, elbow, wrist, and fingers and adduction of the shoulder. The leg is stiff and extended and circumducts with each step. Causes of this type of gait include cerebrovascular accident.
Abnormal findings for Romberg’s test: patient sways; falls; widens base of feet to avoid falling. Positive Romberg’s sign is loss of balance that is increased by closing of the eyes.
Kinesthesia, or position sense, is the person’s ability to perceive passive movements of the extremities.
Which of the following are the most frequently encountered causes of gait disturbances? (Select all that apply)
All of the above are true. These are the most commonly seen etiologies for gait disturbances.
False.It is better to use descriptive terms when describing gait, because different terms may mean different things to different people. Similar to the use of lethargy, obtundation and stupor
It is the syndrome of ophthalmoplegia, confusion and ataxia.
Due to thiamine deficiency from chronic malnutrition
Treatment is hydration, thiamine and glucose.
Inflammatory is the 2nd leading cause of childhood ataxia due to infection or immunizations
Unfortunately intoxication is the most common.
All of the above are important in trying to determine the etiology of ataxia in an adult. However, testing for neurosyphilis in a child is probably unnecessary.
With the same instrument, draw a light stroke up the lateral side of the sole of the foot and across the ball of the foot, like an upside-down “J.” The normal response is plantar flexion of the toes and sometimes of the whole foot.
Dorsiflexion of the big toe and fanning of all toes is a positive Babinski's sign, also called “upgoing toes.” This occurs with upper motor neuron disease of the corticospinal (or pyramidal) tract and is an abnormal finding for adults.
Sometimes the reflex response fails to appear. Try further encouragement of relaxation, varying the person’s position or increasing the strength of the blow. Reinforcement is another technique to relax the muscles and enhance the response. Ask the person to perform an isometric exercise in a muscle group somewhat away from the one being tested. For example, to enhance a patellar reflex, ask the person to lock the fingers together and “pull.”
Hyperreflexia is the exaggerated reflex seen when the monosynaptic reflex arc is released from the influence of higher cortical levels. This occurs with upper motor neuron lesions (e.g., a cerebrovascular accident).
Hyperreflexia, diminished or absent superficial reflexes, increased muscle tone or spasticity can be expected with upper motor neuron lesions.
You place a key in the hand of a patient and he identifies it as a penny. What term would you use to describe this?
You are testing the superficial reflexes on an adult patient. When you stroke up the lateral side of the sole and across the ball of the foot, you notice planter flexion of the toes. How would you document the findings?
The Moro reflex is present at birth and disappears at 1 to 4 months. Absence of the Moro reflex in the newborn or persistence after 5 months of age indicates severe central nervous system injury.
Normally the child can balance on one foot for about 5 seconds by 4 years of age, for 8 to 10 seconds at 5 years of age, and can hop at 4 years. Children enjoy performing these tests. Failure to hop after 5 years of age indicates incoordination of gross motor skill.
Senile tremors occasionally occur. These benign tremors include an intention tremor of the hands, head nodding (as if saying yes or no), and tongue protrusion.
A high-pitched shrill cry or cat-sounding screech occurs with central nervous system damage. Lethargy, hyporeactivity, hyperirritability, and parent’s report of significant change in behavior all warrant referral.
To screen gross and fine motor coordination, use the Denver II with its age-specific developmental milestones.
At 3 months of age, the baby raises the head and arches the back as if in a swan dive. This is the Landau reflex, which persists until 11/2 years of age.
Tone is the normal degree of tension (contraction) in voluntarily relaxed muscles. It shows a mild resistance to passive stretch. Normally, you will note a mild, even resistance to movement.
Let at least 2 seconds elapse between each stimulus to avoid summation. With summation, frequent consecutive stimuli are perceived as one strong stimulus.
Perform a complete neurologic examination on persons who have neurologic concerns (e.g., headache, weakness, loss of coordination) or who have shown signs of neurologic dysfunction.
Chorea is characterized by sudden, rapid, jerky, purposeless movements that involve the limbs, trunk, or face. Chorea occurs at irregular intervals, and the movements are all accentuated by voluntary actions.
With a herniated intervertebral disk or lower motor neuron lesion, there is loss of tone, flaccidity, atrophy, fasciculations, and hyporeflexia or areflexia.
When testing the triceps reflex, what is the expected response?
3. The normal response is extension of the forearm.
assessing a 7-month-old infant you make a loud noise and note the following response: Abduction and flexion of arms and legs; fanning of fingers and curling of index finger and thumb in C-position; followed by infant bringing in arms and legs to body. What do you know about this?
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